Knowledge about iodine requirements during pregnancy and breastfeeding among pregnant women living in Northern Ireland

Knowledge and utilization of iodized salt among expectant mothers in Harar City's public health facilities: a multicenter study in Eastern Ethiopia

BACKGROUND

Insufficient iodine intake during pregnancy can result in abortion, stillbirths, neonatal mortality, cretinism and permanent cognitive impairment. Even although iodized salt is widely accessible in Ethiopia, pregnant women still experience persistent problems related to iodine deficiency disorders.

METHODS

A facility-based cross-sectional study was conducted among randomly selected 573 pregnant women who were attending antenatal care services at public health facilities. Bivariate and multivariable logistic regression models were used, and independent predictors were determined based on adjusted ORs with 95% CIs and p<0.05.

RESULTS

Knowledge and practice of pregnant women on iodized utilization were 35.6% (95% CI 31.8 to 39.6%) and 37.7% (95% CI 32.1 to 42.9%), respectively. Living in urban areas (adjusted OR [AOR]=1.976, 95% CI 1.136 to 3.435) and having a higher level of education (AOR=2.018, 95% CI 1.037 to 3.930) were associated with having adequate knowledge. Having a diploma or higher education (AOR=2.684, 95% CI 1.137 to 6.340) and adequate knowledge about iodized salt utilization (AOR=2.095, 95% CI 1.273 to 3.447) were significantly associated with good practice.

CONCLUSIONS

The current study highlights the level of knowledge and practices of pregnant women on iodized salt. It emphasizes the necessity for targeted programs about the benefits of iodized salt and how to use it correctly, particularly for those with low literacy levels and those living in rural areas.

Assessing Health Care Providers' Knowledge and Practices of Nutrition during Pregnancy in Lebanon: A Cross-Sectional Study

Background and objectives: Health care professionals (HCPs) are well-positioned to discuss healthy behaviors during pregnancy, but the published research of prenatal healthcare providers' knowledge about the significance of nutrition during pregnancy in Lebanon is scarce. The purpose of this study was to explore the knowledge, attitudes, and practices of Lebanese prenatal healthcare providers towards nutrition during pregnancy. Materials and Methods: A cross-sectional study using an online questionnaire was conducted. Health care providers were contacted by phone and email to participate in the online survey. A list of all clinics providing antenatal health services was obtained from the Order of Physicians and the Order of Midwives. A multistage random sample was selected. In the first stage, it was stratified per region (Beirut center or suburbs, and the southern region). In the second phase, it was stratified per clinic type (private, primary healthcare center, or hospital). Gynecologists and midwives who are members of the Order of Physicians and the Order of Midwives (n = 1333), were included. Results: Two-hundred and six responses (55% males) were obtained. Approximately 44% of the HCP were aged 50 and older, and 68.4% had more than 10 years of work experience. HCPs from Beirut represented 41.3% of the respondents. Eighty-eight percent of the HCPs were physicians, and 11% were midwives. The majority of the participants considered nutrition during pregnancy to be very important. Furthermore, half of these participants considered their position in delivering nutrition information as very significant. Most of the respondents reported that they provide nutrition advice to pregnant women, and they also received nutrition education during their profession. However, they perceived their nutrition knowledge as inadequate. Conclusion: Health care providers' attitude towards the importance of maternal nutrition and their confidence in talking about nutrition-related topics with pregnant women were positive despite the lack of knowledge in several areas related to nutrition during pregnancy. Therefore, there is a need for continuing nutrition education for health care providers and the implementation of nutrition education programs to achieve better health outcomes.

A review of current knowledge about the importance of iodine among women of child-bearing age and healthcare professionals

Iodine is required for thyroid hormone synthesis and fetal neurogenesis. Recent population studies in the United Kingdom (UK) have found iodine deficiency among schoolgirls, women of child-bearing age and pregnant women. This review explores knowledge and awareness of iodine among women of child-bearing age and healthcare professionals (HCPs) in the UK, set within a global context. We aimed to identify gaps in iodine knowledge in the current UK setting of iodine deficiency without iodine fortification and where iodine is not included in antenatal guidelines. The search terms ‘iodine knowledge’ and ‘iodine awareness’ were used to identify relevant papers. Iodine knowledge is poor among women of child-bearing age in the UK according to four studies using questionnaires and qualitative methods. They were unsure of dietary sources of iodine and were not consistently provided with relevant information from HCPs during clinical care. Midwives have been recognised as the main providers of dietary information during pregnancy and, although they recognised the importance of their role in providing nutrition advice, they did not feel equipped to do so and lacked confidence in addressing nutritional concerns. Globally, there was a similar lack of knowledge, however, this was somewhat improved by the inclusion of iodine in antenatal care guidelines. Midwives’ knowledge of iodine was poor, as was knowledge among women of child-bearing age. Improved HCP knowledge and effective communication of information to pregnant women and women planning to conceive may help to improve iodine status which is of particular concern in pregnancy.

Iodine knowledge is associated with iodine status in Portuguese pregnant women: results from the IoMum cohort study

Lack of knowledge about iodine has been suggested as a risk factor for iodine deficiency in pregnant women, but no studies have addressed this issue in Portugal. So, the aim of this study was to investigate iodine knowledge among Portuguese pregnant women and its association with iodine status. IoMum, a prospective observational study, included 485 pregnant women recruited at Centro Hospitalar e Universitário de S. João, Porto, between the 10th and 13th gestational weeks. Partial scores for knowledge on iodine importance, on iodine food sources or on iodised salt were obtained through the application of a structured questionnaire. Then, a total iodine knowledge score was calculated and grouped into low, medium and high knowledge categories. Urinary iodine concentration (UIC) was measured in spot urine samples by inductively coupled plasma MS. Of the pregnant women, 54 % correctly recognised iodine as important to neurocognitive development, 32 % were unable to identify any iodine-rich food and 71 % presented lack of knowledge regarding iodised salt. Of the women, 61 % had a medium total score of iodine knowledge. Knowledge on iodine importance during pregnancy was positively associated with iodine supplementation and also with UIC. Nevertheless, median UIC in women who correctly recognised the importance of iodine was below the cut-off for adequacy in pregnancy (150 µg/l). In conclusion, knowledge on iodine importance is positively associated with iodine status. Despite this, recognising iodine importance during pregnancy may not be sufficient to ensure iodine adequacy. Literacy-promoting actions are urgently needed to improve iodine status in pregnancy.

Association of iodine-related knowledge, attitudes and behaviours with urinary iodine excretion in pregnant women with mild iodine deficiency

BACKGROUND

Subsequent to the implementation of the universal salt iodisation policy, China has all but eliminated the iodine deficiency disorders. However, pregnant women are still experiencing mild iodine deficiency. The present study explored factors that could relate to mild iodine deficiency in pregnant women.

METHODS

In total, 2400 pregnant women were enrolled using a multistage, stratified, random sampling method in Shanghai. Data were collected via a standardised questionnaire. The urine samples and household cooking salt samples were collected for the detection of urinary iodine and salt iodine concentrations.

RESULTS

The median urinary iodine concentration (MUIC) was 148.0 μg L^-1 for all participants, and 155.0 μg L^-1 , 151.0 μg L^-1 and 139.6 μg L^-1 in the first, second and third trimesters. The MUIC in the third trimester was significantly lower than that of the first trimester (P < 0.05). The usage rates of iodised salt and qualified-iodised salt were 71.5% and 59.4%, respectively. Iodine-related knowledge score composition ratio was significantly different between the high and low UIC groups (P < 0.05). Participants' MUIC increased significantly with the increases in iodine-related knowledge score (P < 0.001). The third trimester was a significant risk factor for high UIC, whereas high iodine-related knowledge score, actively learning dietary knowledge and having a habit of consuming iodine-rich food were significant protective factors for high UIC (P < 0.05).

CONCLUSIONS

Iodine level is adequate among pregnant women in Shanghai during the first and the second trimesters, although it is is insufficient in the third trimester. Good iodine-related knowledge, attitudes and behaviours are important for pregnant women with respect to maintaining adequate urinary iodine.

Mild to Moderate Iodine Deficiency and Inadequate Iodine Intake in Lactating Women in the Inland Area of Norway

Breastfed infants are dependent on an adequate supply of iodine in human milk for the production of thyroid hormones, necessary for development of the brain. Despite the importance of iodine for infant health, data on Norwegian lactating women are scarce. We measured iodine intake and evaluated iodine status and iodine knowledge among lactating women. From October to December 2018, 133 mother-infant pairs were recruited in a cross-sectional study through two public health care centers in Lillehammer and Gjøvik. Each of the women provided two human milk specimens, which were pooled, and one urine sample for analysis of iodine concentration. We used 24-hour dietary recall and food frequency questionnaire (FFQ) to estimate short-term and habitual iodine intake from food and supplements. The median (P25, P75) human milk iodine concentration (HMIC) was 71 (45, 127) µg/L-of which, 66% had HMIC <100 µg/L. The median (P25, P75) urinary iodine concentration (UIC) was 80 µg/L (52, 141). The mean (± SD) 24-hour iodine intake and habitual intake was 78 ± 79 µg/day and 75 ± 73 µg/day, respectively. In conclusion, this study confirms inadequate iodine intake and insufficient iodine status among lactating women in the inland area of Norway and medium knowledge awareness about iodine.

Knowledge and awareness of iodine intake - survey among Croatian women of reproductive age

Introduction

Appropriate iodine intake is important for the entire population, especially in fertile women due to decisive role of thyroid hormones in normal foetal brain development. The aim of this study was to investigate knowledge on iodine role among Croatian women of reproductive age.

Materials and methods

The survey was conducted among 378 women of reproductive age during May-September 2018. Data on age, education level, salt intake habits, knowledge of the iodine role and possible presence of thyroid disease were collected and results were presented as numbers or percentage of total number of participants. Comparison between groups was performed by Chi square test.

Results

Of 378 participants, 178 reported to be familiar with the iodine role in the body (P = 0.115). Significantly higher proportion of the younger woman and woman with lower degree of education weren’t familiar with the iodine role (P < 0.001). More woman were introduced to consequences of insufficient than to excessive iodine intake (273 vs 213; P < 0.001). In addition, participants mainly weren’t familiar with obligation of salt iodination (P < 0.001). Presence of thyroid disease was recorded in 75 subjects with higher prevalence in subjects 36-49 years (P < 0.001). Presence of thyroid disease was not associated with knowledge on iodine role on health.

Conclusion

Women of reproductive age are not completely aware of the consequences of excessive iodine intake. Thus, further education focusing on more sensitive groups such as woman of younger age should be considered in order to preserve their and their children’s health.

Iodine deficiency among pregnant women living in Northern Ireland

OBJECTIVE

Mild iodine deficiency has re-emerged among school girls in the UK. We wished to study a contemporaneous pregnant population because a relationship between maternal iodine deficiency and offspring cognitive scores has recently been reported. The WHO has set a median population urinary iodine concentration (UIC) of ≥100 and ≥150 µg/L to define adequacy outside of and during pregnancy, respectively. Iodine creatinine ratio (ICR) is also used to correct for dilution effects (sufficiency ≥150 µg/g creatinine in pregnancy).

DESIGN AND METHODS

A total of 241 women were followed across trimesters (T) into the postpartum period (PPP) along with 80 offspring with spot urine sampling and food frequency questionnaires.

RESULTS

Median UIC was 73 µg/L in the 1st T (ICR 102 µg/g creatinine) despite 55% taking iodine-containing supplements. Median UICs were 94, 117 and 90 µg/L in the 2nd T, 3rd T and PPP, respectively. Corresponding ICRs were 120, 126 and 60 µg/g creatinine. ICR was associated with volume of milk consumed throughout pregnancy. Median UIC among the offspring was 148 µg/L, with no difference between the breast- and formula-fed babies.

CONCLUSIONS

Pregnant women living in Northern Ireland may be at risk of iodine deficiency across pregnancy and into the PPP while the offspring are iodine sufficient. This is the first study of its kind in the UK with data for pregnant women and their offspring. The UK does not provide an iodine fortification programme nor offer routine iodine dietary advice in pregnancy and this requires consideration by public health agencies.